The objective of the present study was to investigate the utility of placing a chimney-type (stacked subcutaneous Penrose) drain to prevent surgical site infection (SSI), and particularly superficial SSI (sSSI), following surgery performed for lower gastrointestinal perforation. Subjects and methods: Our subjects were 93 patients who underwent emergency surgery after being diagnosed as having lower gastrointestinal perforation at our hospital from October 2009 to August 2020. All patients not meeting the inclusion criteria were excluded from the study. Subjects were divided into three groups (listed in chronological order): group C, 36 subjects with no drain inserted from 2009 to 2012; group B, 39 subjects in whom closed negative-pressure drains were placed from 2012 to 2017; and group A, 18 subjects in whom chimney-type drains were placed from 2017 to 2020. We retrospectively investigated patient factors, surgical factors, postoperative drain indwelling time, whether sSSI onset occurred and days until sSSI onset. sSSI was diagnosed based on the criteria published by the Japan Nosocomial Infection Surveillance (JANIS) program run by the Japanese Ministry of Health, Labour and Welfare. Results: The incidence of sSSI was lower in group B than in group C, but the difference was not statistically significant. The incidence of sSSI was significantly lower in group A than in group C (5.6% vs 33.3%, p=0.04) and was also lower in group A than in group B, but not statistically significantly so (5.6% vs 20.5%, p=0.24) Discussion: We believe that insertion of a chimney-type drain is useful for preventing sSSI in patients who have undergone surgery to treat lower gastrointestinal perforation.
The right top pulmonary vein (RTPV), a rare pulmonary vein (PV) variant draining the right upper lobe, arises independently from the right superior PV, travels posterior to the right bronchial tree and drains directly into the left atrium (LA) or another PV. We report an RTPV discovered on preoperative computed tomography (CT) scanning in a 60-y-old man who subsequently underwent prone thoracoscopic esophagectomy and subcarinal lymph node dissection. The preoperative CT scan showed an anomalous vessel 7.8 mm in diameter arising from the right upper lobe, running posterior to the right main bronchus (RMB), and draining directly into the LA. To our best knowledge, this is the largest reported RTPV (7.8 mm in diameter) and is an extremely rare variant, passing posterior to the RMB and draining into the LA.
Introduction:The appropriate management of postoperative pancreatic fistula (POPF) after gastrectomy is believed to decrease the incidence of subsequent complications. Previous reports have indicated a relationship between subsequent complications of POPF and drain fluid amylase levels (D-AMY), but this indicator did not offer adequate sensitivity and specificity. In this study, we searched for indicators using highly precise D-AMY levels to predict the onset of subsequent complications. Materials and methods:We performed a retrospective study of 377 patients who underwent gastrectomy between 2014 and 2020 and whose D-AMY levels were measured. D-AMY levels were measured once a day, and we initiated treatment for pancreatitis if levels were ≥ 1500 U/L. We compared the incidence of complications and various clinical factors, including D-AMY level, and also strove to determine a clinically useful cut-off value. Results: There were 64 patients (17.0%) who were diagnosed as having pancreatitis by D-AMY levels ≥ 1500 U/L and required treatment. The significant risk factors were D-AMY ≥ 766 U/L on postoperative day (POD) 2 (p=0.0415, OR=32.46), and a total D-AMY of ≥ 6801 U/L from POD 0 to POD 4 (p=0.0023, OR=55.85). The area under the receiver operator characteristics curve, sensitivity and specificity were 0.84511, 78.6% and 90.9%, and 0.96834, 82.4% and 96.7% for the POD 2 and POD 0-4 cut-off values, respectively. Conclusion:The POD 2 cut-off value correlated with POPF complications after gastrectomy, but the concomitant use of the cut-off value for the period from POD 0-4 facilitated even more accurate prediction of subsequent onset of complications.
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